| Doctor Name: | DR. JOHN DAVID CROCKETT |
| NPI Number: | 1003846106 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 793 Cherokee Rd Lake Forest, IL - 600453149 |
| Business Phone Number: | 8472955377 |
| Business Fax Number: | |
| Mailing Address: | 793 Cherokee Rd, LAKE FOREST |
| State: | IL |
| Postal Code: | 600453149 |
| Phone Number: | 8472955377 |
| Fax Number: | |
| NPI Enumeration Date: | 07/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |